Objectives:To characterize gender and perceived racial representation among academic otolaryngology faculty in the United States and evaluate associations with academic rank, leadership roles, and research productivity. Methods:This cross-sectional study evaluated faculty with professorial titles across 133 Accreditation Council for Graduate Medical Education-accredited otolaryngology residency programs in the United States. Faculty rosters were collected from program websites between October 2024 and March 2025 and supplemented with publicly available sources. Variables included perceived gender, perceived race, academic rank, leadership roles, years in practice, subspecialty training, and h-index. Associations were evaluated using chi-square tests and multivariable ordinal logistic regression. Because demographic variables were assigned from publicly available information rather than self-identification, perceived race was analyzed only as White versus non-White and is interpreted as a limited, socially constructed variable. Results:Among 1697 faculty, 69.1% were male and 68.8% were perceived as White. Women were more represented in pediatric otolaryngology and laryngology, whereas men were more represented in head and neck surgery, neurotology, and comprehensive otolaryngology (p < 0.001). Women were more likely to be assistant professors and men professors (p < 0.001). Women more often held residency leadership roles (9.7% vs. 5.6%; p = 0.002), whereas men more often held fellowship leadership roles (8.4% vs. 5.3%; p = 0.028) and chair positions (5.0% vs. 2.7%; p = 0.026). Men had more years in practice and higher h-indices (both p < 0.001). No significant differences by perceived race were observed in academic rank, leadership, or research productivity. In multivariable analysis, years in practice and h-index independently predicted higher academic rank, whereas gender and perceived race did not. Conclusion:Academic rank was more strongly associated with years in practice and h-index than with gender or perceived race. Perceived-race findings should be interpreted cautiously because binary externally assigned categories may obscure within-group differences. Level of Evidence:4.
Objectives:Burnout syndrome represents a significant concern among physicians, particularly in surgical specialties. This study investigated burnout prevalence among Turkish otolaryngologists and examined the relationship between rhinoplasty practice and burnout dimensions. Methods:A cross-sectional survey was conducted from December 2024 to February 2025, distributing 200 surveys to Turkish otolaryngologists, of whom 84 (42%) completed the validated Turkish 22-item Maslach Burnout Inventory (MBI) and a sociodemographic questionnaire. Statistical analyses included independent t-tests, one-way ANOVA, and correlation analyses. Results:Eighty-four otolaryngologists participated (mean age 38.2 years; 88.1% male). Overall burnout prevalence was low (7.1%). Sixty-four participants (76.2%) performed rhinoplasty surgery. Rhinoplasty surgeons demonstrated significantly higher personal accomplishment scores versus non-rhinoplasty surgeons (3.55 ± 0.68 vs. 2.99 ± 1.02; p = 0.005). No significant differences were observed in emotional exhaustion or depersonalization. Conclusions:Active rhinoplasty engagement is associated with significantly higher personal accomplishment among Turkish otolaryngologists, suggesting rhinoplasty practice may enhance professional fulfillment rather than contribute to burnout. These findings challenge prevailing assumptions about aesthetic surgery's psychological impact. Level of Evidence:4 (cross-sectional study).
Objectives:Hypoglossal nerve stimulation (HNS) is an effective therapy for obstructive sleep apnea (OSA), but its potential auditory side effects are not well studied. This study aims to determine the baseline prevalence of tinnitus in Inspire recipients and assess and characterize new auditory perceptions occurring specifically during device activation. Methods:A retrospective cohort study was conducted using a scripted telephone survey to collect patient-reported outcomes from individuals who received HNS therapy for OSA. Results:Among 70 HNS recipients surveyed, 17.1% (n = 12) reported auditory perceptions occurring specifically during device activation. Patients with preexisting tinnitus were not more likely to report device-related auditory perceptions compared with patients with no history (22.2% vs. 15.4%, p = 0.53), suggesting that preexisting tinnitus does not predispose patients to perceive device activation. No significant associations were found between device-related auditory perceptions and age (p = 0.387), BMI (p = 0.876), device amplitude (p = 0.427), or stimulation frequency (p = 1). Conclusion:In this population, patient demographics and device settings were not predictive of auditory perception onset. A notable percentage of HNS patients reported new stimulation-related auditory sensations unrelated to demographic or device factors. These findings highlight an underrecognized outcome and support increased surveillance and counseling regarding auditory symptoms after HNS implantation.
Objective:To demonstrate the feasibility of restoring intelligible, own-voice speech after total laryngectomy using noninvasive surface electromyography. Methods:One post-laryngectomy patient and one healthy reference speaker silently articulated a closed-vocabulary corpus of 499 dates and times while surface electromyographic (sEMG) signals were recorded from a 20-electrode face, jaw, and neck montage. A decoder mapped sEMG into speaker-independent speech tokens, which a public token-to-speech stack converted into audible speech; for the patient, the output was re-rendered in his own pre-surgical voice using approximately 8 min of audio recorded before surgery. A per-subject procedure identified a reduced electrode subset, and performance was evaluated by five human listeners. Results:The system produced intelligible speech in the patient's own pre-surgical voice. Mean word error rate by human listeners was 20.2% (95% CI 11.0%-31.5%) for the patient and 14.9% (6.8%-24.9%) for the reference speaker. Electrode-selection analysis indicated that roughly half of the recorded electrodes captured 95% of the multi-channel signal (9 of 20 for the patient, 11 of 18 for the reference), supporting more compact hardware. Single-trial recordings showed coordinated muscle activity tracking each silently articulated word despite the absence of phonation. Conclusion:Noninvasive sEMG-based speech restoration is feasible after total laryngectomy. By decoding muscle activity into a speaker-independent representation, the approach sidesteps the absence of post-surgical own-voice audio and remains applicable to patients unable to phonate. Unlike existing alternatives (electrolarynx, esophageal speech, tracheoesophageal puncture), it can also restore the patient's own pre-surgical voice, offering a high-performing, low-complication path toward clinical use. Level of Evidence:4.
Objectives:Large language models (LLMs) are increasingly proposed as clinical decision-support tools; however, their agreement with real-world multidisciplinary tumor board (MDT) decisions remains insufficiently investigated in thyroid oncology. To evaluate the concordance between treatment recommendations generated by ChatGPT 5.2 and Gemini 3.0 and decisions made by a tertiary multidisciplinary thyroid tumor board. Methods:This study included 59 consecutive patients discussed at a tertiary MDT between August and December 2025. Anonymized clinical data, including demographics, ultrasonographic findings, and Bethesda cytology, were provided to both LLMs using standardized structured prompts. MDT decisions were defined as the reference standard. Agreement was assessed using exact concordance rates and Cohen's kappa (κ) statistics with 95% confidence intervals. Results:ChatGPT 5.2 achieved a concordance rate of 71.2% (42/59), demonstrating substantial agreement (κ = 0.623; 95% CI 0.459-0.771). Gemini 3.0 showed a concordance rate of 64.4% (38/59), reflecting moderate agreement (κ = 0.527; 95% CI 0.359-0.684). Discordance increased in complex scenarios involving lateral neck dissection, radioactive iodine therapy, and active surveillance. Conclusions:While LLMs demonstrate promising concordance in standardized thyroid cancer management, they are best positioned as supportive decision aids-such as in MDT preparation and workflow streamlining-rather than replacements for expert multidisciplinary evaluation, particularly in complex clinical scenarios. Level of Evidence:3.
Objective:To characterize synchronous and metachronous contralateral second primary malignancy (SPM) rates across preoperatively defined risk strata in patients with HPV-positive tonsillar squamous cell carcinoma (TSCC) undergoing unilateral versus bilateral tonsillectomy and to evaluate associated postoperative morbidity and functional outcomes. Methods:All patients with HPV-positive TSCC who underwent surgery between 2000 and 2023 were retrospectively reviewed. Fisher's exact test, Kaplan-Meier analysis, and log-rank tests were used to compare morbidity and survival, and multivariable regression models were employed to control for confounders, including patient demographics, substance use, tumor staging, and adjuvant therapy. Results:From 163 patients, 123 (75.5%) underwent unilateral tonsillectomy, 30 (18.4%) low-risk bilateral tonsillectomy, and 10 (6.1%) high-risk bilateral tonsillectomy. Across all patients undergoing bilateral tonsillectomy, synchronous tonsillar SPMs were identified in 10.0%, with rates of 6.7% in the low-risk bilateral group and 20.0% in the high-risk bilateral group. Of the 123 patients who underwent unilateral tonsillectomy, 0.8% developed a metachronous contralateral TSCC at 181.6 months. Among low-risk bilateral patients undergoing prophylactic contralateral tonsillectomy, the NNT for identification of one occult synchronous SPM was 14 (95% CI: 5-50). Bilateral tonsillectomy did not significantly alter discharge diet, postoperative length of stay, hemorrhage rates, return to the operating room, or 30-day emergency department visits. Disease-free survival did not differ significantly across risk-stratified groups. Conclusion:Contralateral second primary TSCC clustered disproportionately among high-risk patients. Bilateral tonsillectomy was not associated with significantly increased postoperative morbidity. These findings support a selective, risk-stratified approach to bilateral tonsillectomy in HPV-associated TSCC, balancing the potential benefit of occult contralateral disease detection against procedure-related morbidity through shared decision-making. Level of Evidence:III.
Objective:Determine whether the Cormack-Lehane airway grade at intubation predicts subsequent tracheostomy in critically ill adults and whether this association persists after controlling for admission diagnosis. Methods:Retrospective multicenter cohort study of 10,234 ICU patients requiring ventilation across three campuses from April 2018 to June 2024. The primary predictor was Cormack-Lehane grade (1-4) during intubation; the primary outcome was tracheostomy. Principal problem documentation classified patients into 12 diagnostic categories. Multivariable logistic regression adjusted for age, sex, BMI, Charlson Comorbidity Index, intubation method, and admission diagnosis. Sensitivity analysis compared the initial versus the worst grade. Results:Of 6189 patients with documented airway grades, 922 (14.9%) underwent tracheostomy. Rates generally increased with grade severity through Grade 3B (24.5%), with Grade 4 (19.4%, n = 31) showing wide confidence intervals consistent with small sample size and high mortality in this subgroup. Otherwise, each ordinal increase in grade conferred 14% higher unadjusted tracheostomy odds (OR: 1.14, 95% CI: 1.05-1.23, p = 0.001). Rates varied by diagnosis, from 28.4% for COVID-19 respiratory failure to 6.5% for gastrointestinal/hepatic conditions. In the fully adjusted model (N = 4770), airway grade remained independently significant (aOR: 1.13, 95% CI: 1.03-1.24, p = 0.014). The strongest predictors were transplant (aOR: 2.95), COVID-19 respiratory failure (aOR: 2.60), and cardiac disease (aOR: 1.84). Patients with Grade ≥ 3 airways had 70% higher odds compared to Grade 1-2B (OR: 1.70, p = 0.002). Patients with worsening grades across re-intubation had higher tracheostomy rates (38.8% vs. 14.2%; OR: 3.8, p < 0.001). The model achieved an AUC of 0.638. Conclusion:Difficult airway anatomy predicts tracheostomy risk after controlling for admission diagnosis, comorbidities, and demographics. Diagnosis provides additional discrimination, with COVID-19, transplant, and cardiac patients at highest risk. Grade worsening across re-intubation identifies an ultrahigh-risk subgroup. These findings support systematic airway grade documentation integrated with clinical context for ICU risk assessment. Level of Evidence:III.
Objective:Evaluate the accuracy, comprehensiveness, and similarity to provider response of ChatGPT-4o in providing patient education regarding microtia and aural atresia management. Methods:Ten standardized inquiries were created across three domains (General Information, Hearing/Anatomy, Treatment Decision-Making) and entered into ChatGPT-4o. Responses were evaluated by an international multidisciplinary cohort of 23 experts, including pediatric otolaryngologists and audiologists. Using 5-point Likert scales, graders assessed factual accuracy, comprehensiveness, similarity to physician responses, and overall quality. Readability was analyzed using Flesch-Kincaid metrics. Results:ChatGPT-generated responses demonstrated high accuracy (mean = 4.03 [SD = 0.66]), comprehensiveness (mean = 4.18 [SD = 0.54]), and similarity to the provider's response (4.02 [0.70]). Audiologists assigned significantly lower ratings than pediatric otolaryngologists regarding accuracy (mean = 3.76 vs. 4.13; p < 0.001) and comprehensiveness (3.94 vs. 4.30; p = 0.046). Qualitative analysis included concerns regarding advanced terminology, omission of specific risks, and a lack of empathetic framing regarding parental guilt. Flesch-Kincaid Reading Grade Level often exceeded the 5th-grade average level for patient education materials (mean = 9.64 [SD = 1.21]). Conclusion:ChatGPT-4o provides reliable introductory information but lacks the technical nuance and multidisciplinary coordination essential for complex microtia care. While a useful adjunct for early information-seeking, ChatGPT-4o lacks the multidisciplinary framing and depth required for ideal counseling.
ABSTRACT Objectives Hypoglossal nerve stimulation (HGNS) is increasingly used in the management of moderate‐to‐severe obstructive sleep apnea (OSA). In this study, we investigated whether common medical and psychiatric comorbidities are associated with apnea‐hypopnea index (AHI) reduction and treatment success after HGNS implantation. Methods Charts of patients who underwent HGNS implantation with pre‐operative AHI of 65 or below were reviewed. ANOVA, linear mixed‐effects model (LMM), and multivariate logistic regression analyses on AHI and demographics and medical comorbidities were performed on RStudio . Outcomes for logistic analysis pertained to whether they met the Sher20 criteria for treatment success. Results A total of 204 patients were included, of whom 174 were male and 30 were female. At the nominal 0.05 threshold, obesity was associated with higher AHI across time in the ANOVA analysis ( F = 7.539, p = 0.0066) and with lower odds of Sher20 treatment success at 6 months (OR = 0.31, 95% CI: 0.10–0.90). In the small CAD subgroup ( n = 16), CAD was associated with a lower longitudinal percent reduction in AHI in the linear mixed‐effects model ( β = −31.88, p = 0.033). No other modeled covariates met the nominal significance threshold. Conclusion Obesity and CAD emerged as potential, rather than established, predictors of less favorable HGNS response. These findings are exploratory and require validation, particularly the CAD association, which was based on only 16 patients and arose in the setting of multiple unadjusted comparisons. Level of Evidence III.
ABSTRACT Objective To evaluate associations between care engagement and psychosocial factors and decannulation success and timing among adults with laryngotracheal stenosis and tracheostomy dependence. Methods This retrospective cohort study included 60 adults with tracheostomy dependence in the setting of laryngotracheal stenosis who underwent airway surgery between September 2021 and November 2025. Patient demographics, clinical history, psychiatric and substance use history, tracheostomy information, surgical information, and follow‐up care were extracted from electronic medical records. Fisher's exact tests, chi‐squared tests, and accelerated failure time models were used to assess associations with decannulation timing and success. Results Forty‐seven patients (78.3%) achieved decannulation. No significant differences in ability to decannulate were found based on age, sex, race, body mass index (BMI), comorbidities, reason for tracheostomy, or stenosis characteristics. Patients who were not decannulated had significantly higher rates of missed appointments (38.5% vs. 8.5% with ≥ 2 no‐shows, p = 0.025) and were more frequently lost to follow‐up ( p < 0.001). Each missed appointment was associated with a 25% increase in time to decannulation ( p = 0.004). Patients with psychiatric diagnoses had a longer time to decannulation, though this relationship was not statistically significant ( p = 0.091). Substance use diagnosis, distance to hospital, social vulnerability index, emergency department visits, and complications were not significantly associated with outcomes. Conclusion Care engagement patterns, including better appointment adherence, were significantly associated with improved decannulation rates in patients with laryngotracheal stenosis. Psychiatric comorbidities may delay decannulation. These findings suggest that interventions targeting consistent follow‐up and mental health support may improve tracheostomy outcomes in this complex patient population. Level of Evidence 4.
ABSTRACT Objectives Quality of life (QoL) outcomes are becoming increasingly important in the era of patient‐centered medicine. This is especially true in head and neck surgical oncology due to the life‐altering effects of major head and neck surgery. This study aimed to gain in‐depth feedback surrounding the awareness, perceptions, and utilization of QoL tools in head and neck surgical oncology among the multidisciplinary team (MDT). Methods A qualitative descriptive content analysis of semi‐structured interviews from 10 members of the head and neck surgical oncology MDT. Results The overarching categories from the interviews were of healthcare practitioners (HCPs) expressing that they thought the assessment of QoL to be important in this patient group and that this was important for clinical practice, patients, and in research. While most respondents assessed QoL, this was largely done on an informal basis, with very few regularly employing formal QoL tools. Various barriers to their use in terms of patient, clinician, and logistical factors were explored. Conclusions Overall, this study adds to the literature by providing an important analysis of perceptions of QoL and formal tools in head and neck surgical oncology from the underexplored perspective of HCPs in this MDT. While clinicians across the MDT generally viewed QoL assessment positively, implementation of structured tools remained inconsistent and was influenced by structural barriers. These findings suggest that future efforts should focus on developing feasible, clinically embedded approaches to QoL integration within this context. Level of Evidence N/A.
ABSTRACT Objective(s) Fungus ball (FB) is a unilateral form of fungal rhinosinusitis, but it remains unclear whether associated microbial dysbiosis is restricted to the lesional sinus or extends across the sinonasal cavity. This study aimed to determine whether bacterial and fungal dysbiosis in maxillary sinus FB is spatially localized by comparing paired lesional and contralateral‐normal sites within the same individuals. Methods This prospective paired‐sample study enrolled 14 adults with surgically confirmed unilateral maxillary sinus FB at a tertiary referral center. Middle‐meatal swabs were obtained from lesional and contralateral‐normal sides during endoscopic sinus surgery. Bacterial and fungal communities were profiled using 16S rRNA gene and internal transcribed spacer (ITS) sequencing. Alpha and beta diversity, taxonomic composition, predicted functional pathways, and bacterial–fungal co‐occurrence networks were analyzed. Results Lesional sinuses showed significantly reduced bacterial alpha diversity compared with contralateral‐normal sides (Wilcoxon p < 0.001) and distinct bacterial beta diversity (PERMANOVA p = 0.003). Fungal beta diversity also differed between sites ( p = 0.001), whereas fungal alpha diversity was preserved. Lesional communities showed enrichment of anaerobic and pathobiont taxa, including Haemophilus , Enterococcus , and Pseudomonas , with reduced relative abundance of Staphylococcus . Although Aspergillus abundance was similar bilaterally, network analysis suggested altered Aspergillus ‐associated connectivity in lesional samples, consistent with a shift in inferred interaction topology rather than increased Aspergillus abundance. Predicted functional analysis further suggested pathway differences that may reflect altered local metabolic conditions. Conclusion In this cohort, microbial dysbiosis in maxillary sinus FB appeared to be spatially localized, with patterns suggestive of anaerobe enrichment and ecological reorganization centered on Aspergillus . These findings are compatible with the standard surgical emphasis on fungal mass removal and restoration of sinus drainage/aeration, but the microbiome‐based relevance of aeration requires confirmation in larger studies. Level of Evidence 3.
ABSTRACT Objective Obstructive sleep apnea (OSA) is associated with chronic low‐grade systemic inflammation. In cases of continuous positive airway pressure (PAP) failure, hypoglossal nerve stimulation (HNS) is a treatment option for OSA but its impact on systemic inflammation to date is unknown. Herein, we investigated changes in cytokines and endothelial markers before and after HNS. Methods Eighteen adults with moderate or severe OSA underwent fasting blood sample collection before and 6–8 months after HNS implantation. Plasma levels of interleukin‐6 (IL‐6), tumor necrosis factor‐α (TNF‐α), vascular endothelial growth factor (VEGF), angiopoietin‐2 (Ang2), C‐reactive protein (CRP), and E‐selectin were measured using ELISA. Clinical metrics, including apnea‐hypopnea index (AHI) and Epworth Sleepiness Scale (ESS), were assessed. Results HNS significantly reduced AHI (from 25.9 ± 13.4 to 14.2 ± 10.5) and ESS scores (from 12.6 ± 5.0 to 7.1 ± 4.0). There were significant decreases in VEGF ( p = 0.033) and TNF‐α ( p = 0.0013) with HNS. CRP levels were elevated among OSA patients when compared with healthy donors and did not change after HNS. IL‐6 levels did not change with HNS, but were low in both healthy and OSA patients. No significant overall changes were observed in Ang2 or E‐selectin. Obese participants exhibited higher baseline inflammatory profiles compared with non‐obese participants. Conclusions In this small cohort, HNS improved OSA severity and was associated with decreases in VEGF and TNF‐α while other inflammatory markers were unchanged. Larger, long‐term studies are needed to understand the potential of HNS to confer cardiometabolic benefits through reduction of systemic inflammation in OSA.
Objectives:Alar reconstruction is common, yet high-quality outcomes data are limited. This review synthesizes the available literature to guide evidence-informed reconstructive choices. Methods:A systematic review identified 35 eligible studies reporting defect characteristics, techniques, and aesthetic, functional, and graft/flap outcomes. Single-patient case reports, purely technical papers, and studies without outcome data were excluded. Results:Full-thickness skin grafts (FTSG), FTSG with cartilage, and composite grafts have been used with acceptable aesthetic outcomes for small defects. Local flaps are most common for small to intermediate defects, while regional flaps, particularly melolabial (MLF) and paramedian forehead flaps (PMFF), are the primary options for larger defects. PMFFs have higher reported cosmetic satisfaction but may require more secondary procedures. Conclusions:Standard data and evidence reporting for alar subunit reconstruction is very limited, with a predominance of retrospective and technique-driven studies and gestalt-based outcomes. Standardized reporting of defect size, functional outcomes, and validated patient-reported measures is needed. Until higher-quality data is available, reconstructive decisions should be individualized.
Objectives:The pathophysiology of patulous Eustachian tube (PET) remains poorly understood. This study characterizes nasopharyngeal anatomy to identify features that distinguish PET patients from controls and determine whether anatomical measurements predict symptom laterality. Methods:Head CT scans from patients with PET diagnosed by Japanese Otologic Society criteria were compared to scans from demographically matched controls. Anatomical features of the Eustachian tube (ET), turbinates, and nasopharynx were measured. PET patients were stratified into bilateral PET, unilateral affected sides, and unilateral unaffected sides. Results:Thirty PET patients (23 unilateral, 7 bilateral) were included. Compared with controls, PET patients demonstrated significantly larger ET orifice diameters (5.61 vs. 4.54 mm, mean difference 1.07 mm, p < 0.001), greater ET patent depth (6.51 vs. 4.76 mm, mean difference 1.74 mm, p < 0.001), larger lateral recess length (6.40 vs. 3.86 mm, mean difference 2.54 mm, p = 0.002), larger lateral recess width (4.37 vs. 2.51 mm, mean difference 1.86 mm, p < 0.001), and greater inferior turbinate-to-ET asymmetry (2.67 vs. 1.24 mm, mean difference 1.43 mm, p < 0.001). Nasopharyngeal dimensions did not differ between groups. No significant differences were identified across groups in the primary analysis. Sensitivity analyses accounting for within-patient correlation demonstrated greater ET patent depth and lateral recess width in symptomatic compared with asymptomatic unilateral PET ears. Conclusion:PET patients demonstrate distinct nasopharyngeal anatomy beyond simple ET patency, including enlarged lateral recesses and greater asymmetry in inferior turbinate positioning. However, anatomical measurements poorly predict symptom laterality, indicating that additional physiologic mechanisms not captured by static CT imaging likely contribute to symptom expression. Level of Evidence:4.
Objectives:Resident physicians commonly experience elevated stress levels and disrupted sleep while on call. Many also report intense cravings for comfort food, typically high in fat, sugar, and salt. The objective of this pilot study was to explore the physiological and psychological factors contributing to the desire for unhealthy food among US otolaryngology residents on call, and to present strategies for reducing these behaviors. The hypothesis was that the introduction of a simple behavioral intervention would be associated with reduced unhealthy food consumption. Methods:Twelve otolaryngology residents from a single academic institution were prospectively enrolled and followed over a 61-day study period consisting of a pre- and post-intervention phase. During the initial 31-day pre-intervention period, participants completed a brief survey following each call shift and reported total sleep duration and whether unhealthy food was consumed. During the subsequent 30-day intervention period, residents were instructed to complete box breathing and/or consume green tea, and reported intervention adherence, sleep duration, and whether unhealthy food was consumed. Results:Survey responses reporting unhealthy food consumption were associated with shorter sleep duration compared to responses reporting no unhealthy food consumption (mean difference = 1.73 h, CI 1.02-2.45, p < 0.0001). Participation in the intervention phase was associated with a reduction in unhealthy eating habits; however, the change was not significant (p = 0.066). Similarly, residents who performed the intervention of box breathing and/or drinking green tea demonstrated fewer episodes of unhealthy food consumption; however, the magnitude of change was not significant (p = 0.857). Conclusion:This pilot study evaluated practical behavioral strategies as potential approaches to reducing unhealthy food consumption during call. Although reductions in unhealthy eating episodes were observed, findings should be interpreted cautiously given the small sample size. Further research is needed to design, implement, and assess strategies that support healthier dietary practices among US resident physicians on call. Level of Evidence:4.
ABSTRACT Objective To map and synthesize the available evidence and evidence gaps on drug‐induced sleep endoscopy (DISE) in infants with obstructive sleep apnea (OSA), focusing on reported sites of obstruction, DISE‐associated management decisions, postoperative outcomes, safety, and limitations in current reporting. Data Sources PubMed/MEDLINE/Embase/Google Scholar was searched for studies published in English and French from January 1980 to September 2025. Review Methods This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR) guidelines. Eligible studies included original reports describing infants under 12 months with OSA who underwent DISE. Two reviewers independently screened titles, abstracts, and full texts, extracted data with a standardized form, and synthesized results descriptively. Extracted variables included available polysomnography (PSG) parameters, DISE methodology, comparator airway evaluations when reported, DISE‐directed interventions, postoperative outcomes, and complications. Results Eight observational studies published between 2013 and 2024 met inclusion criteria, involving 151 infants. DISE often revealed multilevel obstruction, most commonly involving the supraglottis (epiglottis, aryepiglottic folds, arytenoids; including sleep‐state laryngomalacia) and retrolingual airway. Contributors from the nasal and adenotonsillar regions were also reported. DISE findings were associated with variable interventions, most frequently supraglottoplasty and adenoidectomy/tonsillectomy, with selected cases requiring mandibular distraction, tongue‐lip adhesion, or tracheostomy. When postoperative PSG was available, indices generally improved (mean apnea‐hypopnea index [AHI] approximately 10.6 events/h preoperatively and 3 events/h postoperatively). No major DISE‐related complications were consistently described. Conclusion In infants with OSA, DISE appears feasible and may identify dynamic, often multilevel obstruction, particularly supraglottic and retrolingual collapse. However, current evidence remains limited by small retrospective series, inconsistent PSG reporting, variable DISE protocols, and limited objective postoperative outcomes. Prospective studies with standardized DISE methods, uniform PSG reporting, defined outcome measures, and comparator airway evaluations are needed. Level of Evidence 2.
ABSTRACT Background Rhinitis medicamentosa (RM) is associated with prolonged topical nasal decongestant (TND) use and may involve dependency‐like behavioral patterns extending beyond nasal obstruction alone. Existing sinonasal patient‐reported outcome measures do not specifically assess these behavioral features. This study aimed to develop the Rhinitis Medicamentosa Questionnaire (RMQ) and perform a preliminary psychometric evaluation in individuals reporting TND use. Methods Instrument development followed Waltz's four‐stage framework and was informed by Griffiths' addiction model and DSM‐5‐TR substance use disorder criteria. An initial 50‐item pool underwent face and content evaluation involving patients and a multidisciplinary expert panel, resulting in a 37‐item version. A total of 390 Hungarian adults reporting TND use within the previous 12 months completed the online questionnaire. Exploratory factor analysis (EFA; n = 210) and confirmatory factor analysis (CFA; n = 180) were performed on non‐overlapping subsamples. Internal consistency, preliminary test–retest reliability, and score distribution were assessed. Results The final RMQ consisted of 16 items across four factors: Overuse, Salience, Tolerance, and Withdrawal. CFA demonstrated good model fit (CFI = 0.975, TLI = 0.970, RMSEA = 0.055). Internal consistency was high across all subscales (Cronbach's α = 0.872–0.944), and preliminary test–retest reliability was favorable (ICC = 0.92). Higher RMQ scores were associated with more frequent and prolonged self‐reported TND use. An exploratory sample‐derived threshold was identified for higher dependency‐related burden within the study population. Conclusion The RMQ is a newly developed multidimensional questionnaire designed to assess dependency‐related behavioral patterns associated with prolonged TND use. This preliminary study supports its internal structure, reliability, and interpretability. Further validation in clinically confirmed RM populations and international settings is required.
ABSTRACT Objective Accurate preoperative identification of eosinophilic chronic rhinosinusitis (ECRS) is essential for treatment planning and selection of biologic therapies, particularly in Asian populations where inflammatory endotypes are more heterogeneous. We aimed to develop and validate a simplified clinical scoring system using readily obtainable parameters for predicting ECRS. Methods A total of 263 adults with chronic rhinosinusitis undergoing endoscopic sinus surgery were enrolled and divided into a training cohort ( n = 158) and an independent validation cohort ( n = 105). ECRS was defined histologically as ≥ 10 eosinophils per high‐power field. Candidate predictors were evaluated using receiver operating characteristic analysis and multivariable logistic regression to construct a simplified 3‐item ECRS prediction score. Diagnostic performance was compared with the JESREC score using DeLong's test. Results Three independent predictors were identified: blood eosinophil count ≥ 200/μL (three points), computed tomography ethmoid–maxillary (E/M) ratio ≥ 1 (2 points), and presence of nasal polyps (one point). A total score ≥ 4 predicted ECRS. In the validation cohort, the 3‐item score demonstrated good discrimination (AUC = 0.781), with sensitivity 77.3% and specificity 73.8%. Diagnostic performance was comparable to the JESREC score (AUC = 0.840; sensitivity 77.3%; specificity 72.1%), with no significant difference between models (Holm‐adjusted p = 0.206). Conclusion The simplified 3‐item ECRS prediction score provides a practical tool for preoperative prediction of ECRS using routinely available clinical parameters. Despite requiring fewer variables, its diagnostic performance was comparable to the JESREC score, supporting its clinical utility for rapid endotype identification and improved treatment stratification in routine practice.
ABSTRACT Objectives Infection prevention in hospitals is a highly discussed and regulated process for endoscopy in Otolaryngology. The current standard for endoscopes involves high level disinfection (HLD). The UV‐SMART D60 disinfection machine utilizes Impelux UV‐C light technology. This study aimed to evaluate the environmental impact of the D60 machine within an otolaryngology department in comparison to current HLD protocols. Methods Three equipment, materials, and disposables audits were conducted where the turnover and HLD process of a single non‐channeled laryngoscope was analyzed. Every item involved in the cleaning process was documented for both standard HLD and D60 workflows. Water quantity was documented and a power meter was used to determine the wattage of the machinery used. Additionally, scope turnover time was documented and CO 2 emissions were calculated from known quantities. Results Results demonstrated a significant reduction in material usage with the D60 including reduced PPE. The total water usage was about 45 L more per scope for traditional HLD. Power analysis demonstrated a reduction of 250 watts per scope. Additionally, the D60 reduced CO 2 emissions by over a factor of 3500. Scope turnover time was 109 min less for the D60. Conclusions Environmental analysis demonstrates a significant amount of usage of disposables, water, and energy per non‐channeled nasolaryngoscope with current HLD protocols. UV‐C HLD resulted in less consumption of these resources. The marked reduction in turnover time and scope handling represents a significant opportunity for clinical efficiency, cost reduction, and resource consumption and will merit further investigation when FDA approval is granted. Level of Evidence N/A.
